9 Build Habits
1.
Mike Romano was born in 1950 and raised in Milwaukee, the youngest of four brothers. His dad was a handyman who fixed plumbing and heating fixtures. His mom had a commercial art degree; she stayed at home to raise the boys, taking jobs from time to time to pay the bills.
Romano had a temper. In high school, when he was 18, he got into a fight and threw a guy through a window. Afraid of what would happen in court, he enlisted in the army. He figured he was going to be drafted anyway. The court let him go.
Romano eventually ended up being assigned to the 173rd Airborne Brigade in Vietnam, an elite and well-respected unit of paratroopers. The soldiers of the 173rd had an open secret, however: rampant drug use. Others nicknamed them “jumping junkies.” Coming into the military, Romano had no real drug experience. He tried to keep his nose clean with the jumping junkies.
A few months after he arrived in Vietnam, a Claymore land mine detonated near him, and he was struck in his right hand, forearm, and foot. He was taken to a hospital in Camron Bay for recovery. That was where he first tried opium.
He quickly became hooked, like so many others around him. Even when he transferred to other hospitals, his supply wasn’t interrupted. He mostly smoked opium-laced joints, but it was also easy to find liquid opium and even opium chewing gum (not to mention other drugs, such as LSD and marijuana). His addiction continued to torment him throughout his thirteen-month tour of duty.
Romano’s fall into drug use was a typical story during the Vietnam War. The White House was so troubled by reports of drug use among soldiers that it commissioned a study to investigate the scope of the problem. The results were disturbing. Before the war, the typical soldier had only casual experience with hard drugs, and less than 1 percent had ever been addicted to narcotics. But once in Vietnam, almost half of the soldiers tried narcotics, and 20 percent became addicted. Demographics did not predict who would become drug users in Vietnam—race and class were irrelevant.
The drug use started early. Twenty percent of all users started in their first week in Vietnam, 60 percent within the first three months. Oddly, drug use did not seem to be triggered by trauma. The researchers found no statistical relationship between drug use and the difficulty of soldiers’ assignments, or the danger they faced, or the death of friends. Unlike most soldiers, Romano started using opium because he was injured. For most soldiers in Vietnam, drugs were simply a fact of life, a part of the culture.
Government officials were terrified by what would happen when thousands of drug addicts began to return to America. Military and civilian leaders worried that the country’s drug-treatment programs would be flooded, stretched far beyond capacity. They worried that vets might not be able to hold down jobs, that they might turn to crime.
Mike Romano was one of the people the officials were worried about. When he finally boarded his flight back to the United States in 1969, headed home to Milwaukee, he smuggled back with him a stash of opium-laced joints.
Then his life began to change. A week or two after his return home, he was driving with friends in town when he saw a girl he’d known in grade school. “Stop the car!” he said. He chased her down. She was working as a countergirl at a nearby drugstore. “I thought she was very beautiful,” said Romano.
The two started dating. She caught on fairly quickly that Romano was an addict, and she put pressure on him to stop. He tried to quit a few times, but each time he started to feel sick as withdrawal pains kicked in, and then he’d begin using again. Meanwhile, he started work—construction and house painting and other temporary jobs—and he started taking art classes at the University of Wisconsin at Milwaukee. He got a job there designing promotional posters for bands who played at the student union.
After a few quit-and-relapse cycles, he began to wean himself off opium, and within about a month he was clean. He hasn’t touched opium since. What we see in Mike Romano’s life seems like an almost impossible change story: an opium addict who recovered. Mike Romano was one of the lucky ones.
2.
Or was he? White House researchers continued to investigate the drug problem among returning soldiers, and a puzzle started to emerge. Following up with the troops who returned home, the investigators called them eight to twelve months after their return to ask about their ongoing drug use. During the war, 50 percent of soldiers had been casual users, and 20 percent had become seriously addicted, meaning that they used drugs more than once a week for an extended period of time and experienced withdrawal symptoms (chills, cramps, pain) if they tried to stop. But when the investigators conducted the follow-up, what they found blew their minds. Only 1 percent of the vets were still addicted to drugs. That was essentially the same rate as existed before the war. The feared, drug-fueled social catastrophe had not occurred. What had happened?
3.
People are incredibly sensitive to the environment and the culture—to the norms and expectations of the communities they are in. We all want to wear the right clothes, to say the right things, to frequent the right places. Because we instinctively try to fit in with our peer group, behavior is contagious, sometimes in surprising ways.
Imagine that your job was to design an environment that would extinguish drug addiction. You could take drug-addicted U.S. soldiers, drop them into this environment, and feel confident that the forces within it would act powerfully to help them beat their habits. Think of this environment as an antidrug theme park, and assume that you can spend as much as you want to construct it. What would your theme park look like?
It might look a whole lot like Romano’s neighborhood in Milwaukee.
You’d want to surround the former soldiers with people who love them and care about them—and who treat them as the drug-free persons they once were. You’d give them interesting work to do—perhaps designing posters for rock bands—so that their minds would be distracted from the joys of opium. You’d create well-publicized sanctions against drug use. You’d keep the drug economy underground, making the former soldiers sneak around to obtain and use drugs. You’d make sure their girlfriends gave them a hard time about their drug use. You’d set up social taboos so that the soldiers would feel derelict, even pathetic, if they kept using. You’d remove the contagious drug-using behavior from the environment—no more addicted soldiers around—and replace it with contagious drug-free behavior. And you would provide rich environmental cues—sights, songs, food, clothes, and homes—that remind the former soldiers of their prewar, drug-free identities.
The Milwaukee Theme Park: That’s exactly why Mike Romano became a former addict. When Romano relocated to Milwaukee, his environment changed, and the new environment changed him.
4.
As the Romano story shows, one of the subtle ways in which our environment acts on us is by reinforcing (or deterring) our habits.
When we think about habits, most of the time we’re thinking about bad ones: biting our fingernails, procrastinating, eating sweets when we’re anxious, and so on. But of course we also have plenty of good habits: jogging, praying, brushing our teeth. Why are habits so important? They are, in essence, behavioral autopilot. They allow lots of good behaviors to happen without the Rider taking charge. Remember that the Rider’s self-control is exhaustible, so it’s a huge plus if some positive things can happen “free” on autopilot.
To change yourself or other people, you’ve got to change habits, and what we see with Romano is that his habits shifted when his environment shifted. This makes sense—our habits are essentially stitched into our environment. Research bears this out. According to one study of people making changes in their lives, 36 percent of the successful changes were associated with a move to a new location, and only 13 percent of unsuccessful changes involved a move.
Many smokers, for example, find it easier to quit when they’re on vacation, because at home, every part of their environment is loaded with smoking associations. It’s like trying to quit smoking inside a Camel advertisement—everywhere you look are reminders of the habit. There’s that drawer in the kitchen where the lighters are stashed, the clay pot on the porch that’s become an archive of ashes, the ever-present scent of smoke in the car and the closet. When a smoker goes on vacation, the environment recedes toward neutrality. That doesn’t mean it’s easy to quit, but it’s easier.
It’s unrealistic, however, to think that most of us can shift our environment so dramatically. If you’re trying to change your team’s habits at work, then yes, relocating your office would be a big help. Good luck selling that idea. What are some more practical ways to create a habit?
The first thing to realize is that even small environmental tweaks can make a difference—that’s what we saw in Chapter 8. Remember how Amanda Tucker rearranged her office to make it easier for her to listen to her employees? That was the first step in establishing a new habit. (Environmental tweaks can even force a habit, as we saw in the Rackspace example. When the call-queuing system was thrown out, the customer-service staffers quickly developed the habit of answering the phone.)
But forming a habit isn’t all environmental—it’s also mental. It would be very difficult, for instance, to tweak the environment in a way that would compel you to learn how to play the piano. So how do you lay the mental groundwork for a new habit?
5.
Say that you’ve been putting off going to the gym. So you resolve to yourself: Tomorrow morning, right after I drop off Anna at school, I’ll head straight to the gym. Let’s call this mental plan an “action trigger.” You’ve made the decision to execute a certain action (working out) when you encounter a certain situational trigger (the school circle, tomorrow morning).
Peter Gollwitzer, a psychologist at New York University, is the pioneer of work in this area. He and colleague Veronika Brand-statter found that action triggers are quite effective in motivating action. In one study, they tracked college students who had the option to earn extra credit in a class by writing a paper about how they spent Christmas Eve. But there was a catch: To earn the credit, they had to submit the paper by December 26. Most students had good intentions of writing the paper, but only 33 percent of them got around to writing and submitting it. Other students in the study were required to set action triggers—to note, in advance, exactly when and where they intended to write the report (for example, “I’ll write this report in my dad’s office on Christmas morning before everyone gets up”). A whopping 75 percent of those students wrote the report.
That’s a pretty astonishing result for such a small mental investment.
Does this mean that simply by imagining a time and place where you’ll do something, you increase the likelihood that you’ll actually do it? Yes and no. Action triggers won’t get you (or anyone else) to do something you truly don’t want to do. An action trigger never would have convinced college students to participate in an online calculus camp on Christmas Day. But, as the extra-credit study demonstrates, action triggers can have a profound power to motivate people to do the things they know they need to do.
Peter Gollwitzer argues that the value of action triggers resides in the fact that we are preloading a decision. Dropping off Anna at school triggers the next action, going to the gym. There’s no cycle of conscious deliberation. By preloading the decision, we conserve the Rider’s self-control.
The concept of preloading is easier to see with an example. Imagine that you are one of the college students in Gollwitzer’s study. It’s Christmastime, and you’re at home. Your parents are doting on you, and your siblings are having an interesting conversation. The TV is on, the Christmas tree is lit up, and your elderly Chihuahua Fredo is staring at you adoringly. Let’s not forget the food—turkey and dressing, pecan pie, chocolate truffles—and Guitar Hero, and naps, and the calls you’re getting from old high school friends. Distractions are everywhere. So if you walk into this buffet line of stimuli and you haven’t preloaded a decision about your extra-credit report—if you haven’t told yourself, “I’ll do this report in my dad’s office on Christmas morning before everyone gets up”—you are sunk.
That’s why action triggers have unexpected value. Gollwitzer says that when people predecide, they “pass the control of their behavior on to the environment.” Gollwitzer says that action triggers “protect goals from tempting distractions, bad habits, or competing goals.”
There are countless ways to use action triggers at work. If your salespeople are more motivated to close new business than to cultivate existing relationships, give them a “coffee and call” trigger. Tell them that whenever they pour their first cup of coffee, they are to place a check-in call to one of their most important customers. Or think about your employees who will be attending an industry conference. By the time they get back to the office, their e-mail will be so backed up that they won’t be in the mood to share their learnings. So give them an action trigger—suggest that during the flight home, whenever the “OK to use electronics” announcement is made, they type up some reflections for everyone on the team. Action triggers simply have to be specific enough and visible enough to interrupt people’s normal stream of consciousness. A trigger to “praise your employees when they do something great” is too vague to be useful.
Gollwitzer has shown that action triggers are most useful in the most difficult situations—the ones that are most draining to the Rider’s self-control. One study analyzed people’s success in accomplishing “easy” goals or “hard” goals. With easy goals, the use of action triggers increased success only slightly, from 78 to 84 percent. But with hard goals, action triggers almost tripled the chance of success—goal completion skyrocketed from 22 to 62 percent.
To see how action triggers can aid people in difficult times, consider a study of patients recovering from hip-or knee-replacement surgery. On average, the patients were 68 years old, and they had been in pain for about a year and a half before the surgery. The surgeries initially make things even worse; they take such a toll on the body that the patients require assistance with the basic tasks of daily life, such as bathing, getting into bed, and even standing up. The road to recovery can be long and painful.
All patients aspired to get back on their feet as soon as possible, of course. But patients in one group were asked to set action triggers—for instance, “If you are going to go for a walk this week, please write down when and where you plan to walk.”
The results of the study were dramatic. On average, action trigger patients were bathing themselves without assistance in 3 weeks. Other patients took 7 weeks. Action-trigger patients were standing up in 3.5 weeks. The others took 7.7 weeks. In just over 1 month, the action-trigger patients were getting in and out of a car on their own. The others took 2.5 months.
Gollwitzer says that, in essence, what action triggers do is create an “instant habit.” Habits are behavioral autopilot, and that’s exactly what action triggers are setting up. Here’s the proof of the “instant habit” concept: One study showed that the single biggest predictor of whether women gave themselves a monthly breast examination was if they had a habit of doing so. When another group of women who didn’t have such a habit were asked to set action triggers, they ended up doing just as well as the women with longtime habits. By preloading a decision, they created an instant habit.
Action triggers are not foolproof, of course. Teens with a serious smoking habit, for example, did not reap any benefit from setting action triggers to quit smoking. Their nicotine-enhanced habit was simply too strong.
But even though action triggers aren’t perfect, it’s hard to imagine an easier way to make an immediate change more likely. A recent meta-study that analyzed 8,155 participants across 85 studies found that the typical person who set an action trigger did better than 74 percent of people on the same task who didn’t set one.
Instant habits. This is a rare point of intersection between the aspirations of self-help and the reality of science. And you can’t get much more practical. The next time your team resolves to act in a new way, challenge team members to take it further. Have them specify when and where they’re going to put the plan in motion. Get them to set an action trigger. (Then set another one for yourself.)
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How Can You Get Workers to Respect a New Safety Policy?
SITUATION Patti Poppe is a department manager in the General Motors automotive plant in Lordstown, Ohio, and she is struggling with how to roll out a new safety policy. Her department, composed of 950 people, is responsible for welding big pieces of metal onto the skeletal car frames. The work can be dangerous. The edges of the metal are sharp when they come off the presses. If a worker puts his hand on an edge and leans against it, the metal will slice his hand. For that reason, gloves and protective clothing are essential. Also, welders wear goggles, but they are sometimes hurt when sparks fly into their eyes from the side. So the new policy prescribes goggles with protective side shields. The old safety policy was complex and filled with exceptions—for instance, a worker driving a forklift didn’t have to wear safety equipment. Poppe says, “Everyone thinks they fall under the ‘this doesn’t apply to me’ clause.” She is determined to get everyone to take the new policy seriously. (This was a real situation.)
WHAT’S THE SWITCH AND WHAT’S HOLDING IT BACK? Poppe wants the workers to protect themselves from lacerations and sparks. There are three potential barriers. First, the complexity of the old policy may have deterred some workers from embracing it. Remember that what looks like resistance is often a lack of clarity. Poppe needs to script the critical moves. Second, in any safety situation, a “macho” vibe often comes into play. That’s an identity problem. If it seems manlier to ditch the goggles than to wear them, then the Elephant will resist. Third, social pressure is working against safety, because of the “this doesn’t apply to me” sentiment. Poppe needs to flip that social norm. Also, might there be ways to use the environment to cue the right behaviors?
HOW DO WE MAKE THE SWITCH?
• Direct the Rider. 1. Script the critical moves. Poppe threw out the old complicated policy and boiled down the new safety policy to two specific behaviors: (1) Everyone is required to wear hard side shields and safety glasses. (2) No one can expose any bare skin (no shorts or short-sleeve shirts). That’s it. Then Poppe found a way to make these rules very concrete. At an all-hands meeting, she hosted a safety “game show.” A worker was called onstage to be the contestant; he was asked to assess whether a series of models was in compliance with the new safety rules. Some of the models violated the code in subtle ways, such as wearing safety glasses with one eyepiece missing. She invited audience members to help the contestant, and they shouted out answers, thereby rehearsing and absorbing the new behaviors expected of them. 2. Point to the destination. Poppe worried about rationalization, the excuse that “this doesn’t apply to me.” So she created a B&W goal to eliminate the wiggle room. If you were in the plant, you were required to follow the two rules, regardless of what you were doing. The rules applied to everyone at all times.
• Motivate the Elephant. 1. Grow your people. Macho men don’t like to wear dorky safety glasses. Maybe Poppe could find glasses that look more like Bono’s and less like a junior-high-school shop teacher’s. That might make the change less of an identity threat.
• Shape the Path. 1. Rally the herd. By requiring everyone in the plant to wear the safety gear at all times, Poppe is flipping the social norm in favor of compliance. When you look around and everyone is wearing safety glasses, you are more likely to wear them yourself. 2. Build habits. Poppe added one final, inspired touch: She painted a large blue line around the plant and made the new safety policy effective anywhere inside the line. Also, at the entry points, she posted blue wooden men who are wearing the appropriate gear. By installing the blue line and the blue men, Poppe was basically introducing an action trigger. She was training the workers to think, When I cross this line, that’s my cue to put on my gear. The action trigger helped make the behavior habitual.
[What happened: As a result of Poppe’s innovations, injuries at the plant dropped 21 percent from previous levels (which were already among the best of manufacturers doing similar work).]
6.
Habits are behavioral autopilot, and that’s why they’re such a critical tool for leaders. Leaders who can instill habits that reinforce their teams’ goals are essentially making progress for free. They’ve changed behavior in a way that doesn’t draw down the Rider’s reserves of self-control.
Habits will form inevitably, whether they’re formed intentionally or not. You’ve probably created lots of team habits unwittingly. If your staff meetings always start out with genial small talk, then you’ve created a habit. You’ve designed your meeting autopilot to yield a few minutes of warm-up small talk. The hard question for a leader is not how to form habits but which habits to encourage.
General William “Gus” Pagonis led the logistics operation for the Gulf War under President George H. W. Bush. Pagonis was responsible for moving 550,000 troops halfway around the world, along with all of their equipment. His team made the arrangements to serve 122 million meals, pump 1.3 billion gallons of fuel, and deliver 32,000 tons of mail. Even a Wal-Mart executive would get spooked thinking about this.
Needless to say, clear and efficient communication was essential. Every morning, General Pagonis held a meeting that started at 8 a.m. and ended at 8:30. No great innovation there, but Pagonis made two changes to the routine. First, he allowed anyone to attend (and he required that at least one representative from each functional group be present). That way, he could ensure a free and open exchange of information across the organization. Second, he required everyone to stand up during the whole meeting.
Here’s Pagonis on the benefits of the stand-up meeting:
Early on, I discovered that making people stand up keeps the ball moving at a quicker pace. People speak their piece and then quickly yield the floor to the next person. On the rare occasion that someone starts to get long-winded or wax philosophic, an unmistakable kind of body language begins to sweep through the crowd. People shift from foot to foot, fidget, look at their watches—and pretty quickly, the conversation comes back into focus…. I can’t recall the last time I had to crack the whip. The peer group has great power.
Pagonis was consciously creating a habit. Any meeting format he chose would have quickly become habitual. It would have been just as easy for him to enshrine a two-hour, seated blabfest. What’s exciting here is not the existence of the habit, but rather the insight that the habit should serve the mission. When you’ve got 550,000 troops to relocate, you need focus and clarity and efficiency. A stand-up meeting won’t guarantee any of that, but it will help, and it’s “free”—it’s not any harder to create than the blabfest would have been. (Similar stand-up meetings are used in Agile programming projects in Silicon Valley, which place a premium on quick collaboration.)
How can you create a habit that supports the change you’re trying to make? There are only two things to think about: (1) The habit needs to advance the mission, as did Pagonis’s stand-up meetings. (2) The habit needs to be relatively easy to embrace. If it’s too hard, then it creates its own independent change problem. For instance, if you’re trying to exercise more and you decide to “create a habit” of going to the gym, you’re really only renaming the core problem. It might be more productive to try to start by building an easier habit, like laying out your gym clothes before you go to bed or asking a friend who already works out to pick you up on his way to the gym.
Consider a one-year study of dieters conducted at Penn State University. A baseline diet condition led to weight loss of 17.8 pounds over the course of the year. That’s an impressive result, but the drawback of many diet programs is that once the program ends, the dieters’ old habits start to reemerge and their weight begins to creep up again. In this study, one warning flag was that only 36 percent of the people in the baseline condition rated themselves as “very full” or “extremely full” on the diet. How sustainable is a diet that doesn’t make you really full?
Other dieters in the same study were asked to eat two cups of soup each day, in addition to their regularly scheduled meals. The two cups of soup were bonus food. These dieters lost 15.4 pounds over the year, and 55 percent of them rated themselves as “very full” or “extremely full.” They didn’t lose quite as much weight, but their odds of feeling full went up substantially. Eating two cups of soup is a classic supporting habit. It was an easy habit to implement—the researchers were simply asking the dieters to eat more. And it helped the broader mission—it helped the dieters feel full, which made it easier for them to control their portions at mealtime.
7.
This focus on creating habits was used masterfully, in a totally different context, by Natalie Elder, an elementary school principal in Chattanooga, Tennessee. When Elder was first considering the job as principal of Hardy Elementary School, she asked to see a copy of the school’s results on statewide tests. As it turned out, she didn’t get to see the data until after she’d already accepted the job. Looking back, she joked that the school board tricked her into taking the job first.
When Elder finally saw the scores, she could not believe what she was reading. Hardy Elementary didn’t just have low test scores; it had the lowest scores in the state of Tennessee. She wondered, “What have I gotten myself into?”
It was a brutal beginning, but things got even worse. On the first day of school, she had to expel a student. Every week, it seemed, Elder encountered a new form of bad behavior. In the classrooms, students were cussing at their teachers. (Remember, we’re talking about 6-to-8-year-old kids.) Parents sometimes barged into classrooms in the middle of a lesson to talk to their kids. One parent was escorted out of the building in handcuffs after he verbally abused the cafeteria manager.
Elder’s attempts to restore discipline in the school were met with resistance. “Parents were coming in and cussing at me, hollering at me. One parent tried to run me over with a car,” she said. Elder wasn’t facing a teaching problem or a learning problem. She was facing something much more fundamental. She said, “I knew I had to get control of the building before I could teach.”
She forbade parents from entering the building during school hours without permission from her office. She suspended the chronic misbehavers in the classroom. She got the police involved, when necessary, to enforce the new rules.
But those actions were just a way of eliminating the really egregious behavior. Her real goal was to transform chaos into calm. In her judgment, the trouble began the moment students arrived at school. If students were rowdy by 8:30 a.m., Elder reasoned, there wasn’t much hope for the rest of the day. She resolved to conquer the morning by creating a series of consistent routines that would settle the students and prepare them to learn.
The problems began in the driveway where parents dropped off their kids each day. Elder said that often “the mom would already be yelling at the child, and sometimes the music was going BOOM-ta-ta-BOOM, and by the time the kid comes into the building, they’re already upset or angry.” So Elder and her staff did something amazing: They turned themselves into valets.
They resolved to greet every student before he or she entered the school building. They waited at the curb outside, opened car doors for the kids, smiled and said good morning to the parents, and then walked each child inside to the cafeteria. Their valet service helped smooth the transition to the school day from what for many kids was a raucous home environment.
Once the kids were gathered inside the cafeteria, Elder started every day with a disciplined group assembly. “Continuity is good for any child,” she said. “What these kids don’t get in their lives is stability. They have to know that here they’ll get structure and order.”
At the assembly, Elder began with announcements and a brief call-and-response with the kids. “We’re a school of what?” a teacher would call out. The kids would respond by shouting, “Excellence!” At 7:50, Elder taught a brief lesson in character education, typically focusing on a single word, such as perseverance. She’d have volunteers spell the word and define it. At 7:55, everyone stood and said the Pledge of Allegiance, then sang a patriotic song (for instance, the Whitney Houston version of “America”). Sometimes kids read aloud, or Elder gave them a quick spelling or math quiz. (Often the prize was a coveted “out of uniform” pass for Friday, allowing them to wear what they wanted.)
At 8:00, the kids stood and silently walked to class with “traveling arms,” meaning that the kids’ arms were folded behind them, reducing the nearly irresistible urge to mess with their friends. By the time the kids sat down at their desks, they were ready to learn.
Elder shows us how new habits can clear the Path. She inherited chaos at Hardy Elementary School, and she asked herself, “Which parts of this chaos can I tame? What kind of morning routine can I set up that will improve the chances that the kids are ready to learn?”
She had to fight the forces that stirred up kids before they’d even set foot in the classroom: the tense drop-offs, the cafeteria pandemonium, the erratic transition to the classroom. By bringing order and continuity to the environment, she was able to create forward movement for a group of children who’d grown used to a destructive cycle of behavior.
Notice, too, that because of the calm environment that Elder managed to create, “bad” kids started acting like good kids. A good change leader never thinks, “Why are these people acting so badly? They must be bad people.” A change leader thinks, “How can I set up a situation that brings out the good in these people?”
8.
So far, as we’ve discussed how to shape the Path, we’ve encountered two strategies: (1) tweaking the environment and (2) building habits. There’s a tool that perfectly combines these two strategies. It’s something that can be added to the environment in order to make behavior more consistent and habitual.
That tool is the humble checklist. We discuss it with some trepidation, because we know the associations buzzing in most readers’ heads: mundane, routine, bureaucratic. “Use a checklist,” we admit, sounds like advice a dad would give a college student, along with some tips on tire-pressure gauges and not charging beer to his Exxon card.
But bear with us, because your perceptions are about to change. What if we asserted that checklists can be game-changing, that checklists can save lives?
The Holy Grail of checklists may be one reported by Atul Gawande in The New Yorker. Patients in intensive care units (ICUs) often have intravenous lines put in to deliver medication. If those lines become infected, nasty health complications can result. Frustrated by these “line infections,” which are preventable, Dr. Peter Pronovost of Johns Hopkins compiled a five-part checklist.
The checklist contained straightforward advice: Doctors should wash their hands before inserting a line, a patient’s skin should be cleaned with antiseptic at the point of insertion, and so on. There was no new science in the checklist, nothing controversial. Only the results were surprising: When the checklist was put into practice by Michigan ICUs over a period of eighteen months, it nearly eliminated line infections, saving the hospitals an estimated $175 million because they no longer had to treat the associated complications. It also saved about fifteen hundred lives.
How can something so simple be so powerful? Checklists educate people about what’s best, showing them the ironclad right way to do something. (That means that checklists are effective at directing the Rider.) As Dr. Pronovost said, his five steps were black and white, backed by solid medical research. You could ignore the checklist, but you couldn’t dispute it.
Even when there is no ironclad right way to do things, checklists can help people avoid blind spots in a complex environment. Has your business ever made a big mistake because it failed to consider all the right information? A checklist might have helped. Cisco Systems, one of the largest internet hardware companies, uses a checklist to analyze potential acquisitions: Will the company’s key engineers be willing to relocate? Will we be able to sell additional services to its customer base? What’s the plan for continuing to support the company’s existing customers? As a smart business development person, you’d probably remember to investigate 80 percent of these critical issues before any deal is struck. But it would be inadvisable to recall the other 20 percent after the close of a $100 million acquisition. (Whoops! Those hotshot engineers refuse to leave the snow in Boulder.) Checklists provide insurance against overconfidence.
And overconfidence is worth insuring against because we all have a knack for it. In one classic study, people were asked to come up with solutions for their university’s chronic parking problem. Ideas ranged from raising parking fees to creating more “Compact Only” parking spaces. After the ideas were collected, a panel of experts assessed them—eliminating wacky or impractical options—and identified a set of “best solutions.”
The average individual brainstormer came up with 30 percent of the best solutions, which is pretty good for a solo effort. Here’s what’s not so good: The brainstormers confidently predicted that they’d identified 75 percent of the best ideas. (We all know people who believe that the world’s accumulated wisdom only adds an incremental 25 percent to their own contribution. You may have married one of them.)
A checklist could have helped these people. Imagine if you’d provided them with a list of “solution categories” to guide their thinking, reminding them to think about “solutions that raise the cost of parking” and “solutions that help more cars park in the same amount of space” and so on. That list would have served the same role as Cisco’s acquisition categories; it would have sparked their thinking and kept them from forgetting key areas of consideration.
People fear checklists because they see them as dehumanizing—maybe because they associate them with the exhaustive checklists that allow inexperienced teenagers to operate fast-food chains successfully. They think if something is simple enough to be put in a checklist, a monkey can do it. Well, if that’s true, grab a pilot’s checklist and try your luck with a 747.
Checklists simply make big screwups less likely. As Dr. Pronovost said, “We wanted people to standardize on the mission-critical elements—the areas where we have the strongest evidence. And these things that are mission-critical, we’ve got to do them every time.”
What does your organization need to do in every product cycle? What do you need to check for in every contract or negotiation? What does your family need to do to prepare for each new school year? Put these things in a checklist. You may not save a life, but you’ll sure avoid a painful blind spot.
You’ll also avoid making the Fundamental Attribution Error. Dr. Pronovost’s research showed that line infections—life-threatening problems that are preventable—were rampant. Yet he didn’t conclude, “We’ve got a health care system full of sloppy, negligent doctors.” Instead, he asked himself, “How can I change these doctors’ situations so that they’re more likely to avoid line infections?” (So before you conclude that your husband is hopelessly absentminded, always forgetting to pick up the dry cleaning and the milk, maybe you should try shaping his Path. How about taping a checklist to his steering wheel?)
As you try to make a switch, the hardest struggle will be to maintain your motivation, to keep your Elephant on the road. This puts a huge burden on your Rider, who has to rein in the Elephant when it strays. In this chapter, and the last one, we’ve been searching for ways to use the environment to relieve the Rider’s burden. We started with the story of Mike Romano, the soldier who came back from Vietnam with an addiction to opium. If Romano’s fate had hinged solely on the one-on-one battle between his Rider and his Elephant, he couldn’t have kicked his addiction. It was the environment that tipped the forces in his favor. When Romano came back to his hometown of Milwaukee, he found it a lot easier to change.
How can you create an environment that would make it easier for you, or your team, to change? We’ve seen that supportive habits—like holding stand-up meetings or eating two daily bowls of soup—can help, and so can action triggers that allow you to preload difficult decisions. Even a simple checklist can make a difference. In the next chapter, we’ll get the final piece of the puzzle: the influence of other people. It’s easier to persevere on a long journey when you’re traveling with a herd.